Answers

2. d. Use the carotid and femoral arteries. Because they're larger and closer to the heart, they more accurately reflect the heart's activity.

3. b. These factors combined will give you a clear understanding of your patient's symptoms. They stand for:

* P: Provoking/palliative

* Q: Quality/quantity

* R: Region/radiation

* S: Severity

* T: Timing.

4. a. In normal infants and children, sinus arrhythmia (heart rate faster in inspiration and slower on expiration) almost always is present.

5. c. Resonant percussion sounds-described as long, loud, and low-pitched-typically are found over normal lung tissue. You'll usually find these percussion sounds over most of the chest.

6. a. Wheezes are adventitious lung sounds with a relatively high-pitched, musical quality that may be heard on inspiration or expiration.

7. d. A child with parainfluenza virus-induced croup begins with an upper respiratory tract infection, followed by hoarseness and a "barking seal" cough. Chronic or recurrent episodes of cough may be caused by asthma, especially if the cough is dry or produces clear mucus. Persistent cough with purulent sputum suggests disorders, such as cystic fibrosis or bronchiectasis.

8. d. Both S1 and S2 are relatively high-pitched sounds. S1 usually is louder than S2 at the apex; S2 usually is louder than S1 at the base.

9. c. Listen for the scratchy, rubbing sound with the patient sitting upright, leaning forward, and exhaling. Although this position brings the heart close to the chest wall, you may need to ask the patient to hold his breath if you have trouble hearing the sound.

10. b. Use the grading system to describe the intensity of the murmur. Grade 2 of 6 describes a murmur that's audible when you place your stethoscope on his chest, but quiet and soft.

12. a. Tympany usually predominates when percussing the abdomen because of gas in the gastrointestinal tract. It's also typical to find scattered areas of dullness due to the presence of fluid and feces.

13. a. You'll usually find the bulge sign in the knee.

14. d. Vesicles are fluid-filled lesions that glow when transilluminated.

15. b. An asymmetric lesion with an irregular border may indicate malignancy.

17. a. The upper outer quadrant, where half the ductal tissue is located, is the most common site of malignant breast tumors.

18. a. Discharge that's mucoid, clear, or white and nonbloody and odorless is produced by the cervical mucosa and vulvar glands. It may be scant or profuse due to estrogenic stimulation and changes during menses.

20. b. A disorder of the inner ear, the cochlear nerve, or its central connections, sensorineural hearing loss impairs the transmission of nerve impulses to the brain. Conductive hearing loss results from external or middle ear disorders that block sound transmission; mixed hearing loss, from a combination of conductive and sensorineural problems; and functional hearing loss occurs for no organic reason and is thought to be caused by emotional or psychological factors.

21. b. Because cranial nerves IX and X innervate the pharynx as well as the middle and external ear, throat pain and ear pain commonly occur together.

22. c. Dysphagia is the most common, and sometimes the only, symptom of an esophageal disorder, such as esophageal cancer or esophageal diverticulum.

23. a. A basilar skull fracture, which is life-threatening, can cause cerebrospinal rhinorrhea with nasal obstruction.